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Episode 29 Gestational Diabetes

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Answers for Episode 28 Polycystic Ovarian syndrome

Question 1: Diagnosis and Pathophysiology

A 24-year-old woman presents with irregular menstrual cycles and concerns about excessive facial hair. Physical examination reveals mild hirsutism and acne. Laboratory testing shows mildly elevated total testosterone and normal thyroid function. Transvaginal ultrasound reveals 24 follicles in the right ovary and an ovarian volume of 12 mL. Which of the following best explains the underlying pathophysiology of this patient’s condition?

C. Increased luteinizing hormone (LH) secretion and insulin resistance

Question 2: Management

A 29-year-old woman with PCOS and a BMI of 32 kg/m² presents with concerns about infertility. She has been attempting to conceive for 8 months. Her cycles are irregular, occurring every 40–60 days. She is not on any medications. Which of the following is the most appropriate first-line pharmacologic treatment to induce ovulation?

B. Letrozole

Question 3: Long-Term Complications

A 35-year-old woman with a history of PCOS presents for a routine follow-up. She has a BMI of 28 kg/m² and reports daytime fatigue and snoring. Which of the following long-term complications is she at significantly increased risk for, independent of her BMI?

B. Obstructive sleep apnea

Paper for next week:

Geoffrey Hackett, Michael Kirby, Rowland W. Rees, T. Hugh Jones, Asif Muneer, Mark Livingston, Nick Ossei-Gerning, Janine David, Jeff Foster, Philip A. Kalra, Sudarshan Ramachandran, The British Society for Sexual Medicine Guidelines on Male Adult Testosterone Deficiency, with Statements for Practice, World J Mens Health 2023 Jul 41(3): 508-537

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Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 28 Polycystic Ovarian Syndrome

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Answers for Episode 27 Metabolic Syndrome

Question 1: Pathophysiology

A 52-year-old male with central obesity, elevated triglycerides, and hypertension is diagnosed with metabolic syndrome. Which of the following best describes the role of free fatty acids (FFAs) in the development of insulin resistance in this condition?

C. FFAs impair insulin signaling by altering the insulin receptor substrate pathway

Question 2: Clinical Biomarkers

Which of the following biomarkers is most consistently decreased in patients with metabolic syndrome and is known for its anti-inflammatory and insulin-sensitizing properties?

C. Adiponectin

Question 3: Diagnostic Criteria

According to the harmonized definition by the International Diabetes Federation and the American Heart Association/NHLBI, which of the following combinations qualifies a patient for a diagnosis of metabolic syndrome?

C. Central obesity, low HDL cholesterol, and elevated blood pressure

Paper for next week:

Thomas A. Buchanan, Anny H. Xiang, Kathleen A. Page, and Richard M. Watanabe, What Is Gestational Diabetes—Really?, Diabetes 2025;74:1037–1046

Important legal things:

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 23.1 Amber Healy DO Diabetologist

A fantastic conversation with one of my favorite colleagues. A lot to learn from Dr. Healy’s wisdom about a massive problem for American Medicine. I hope you enjoy the discussion as much as I did.

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Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 27 Metabolic Syndrome

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Answers for Episode 26 Obesity

Question 1: Clinical Decision-Making in Obesity Pharmacotherapy

A 45-year-old woman with a BMI of 34 kg/m² and type 2 diabetes has attempted multiple lifestyle interventions with limited success. She is interested in pharmacologic therapy for weight loss. Which of the following medications is most likely to result in the greatest average weight loss?

C. Tirzepatide 15 mg subcutaneous weekly

Question 2: Understanding Lifestyle Intervention Outcomes

Which of the following statements best describes the expected outcome of intensive lifestyle intervention (ILI) for obesity management?

B. ILI leads to an average weight loss of 2–9% at 1 year, with some regain over time.

Question 3: Post-Medication Management Strategy

A 52-year-old man with obesity (BMI 38 kg/m²) has been taking semaglutide 2.4 mg weekly for 12 months and has lost 17% of his initial body weight. He asks if he can stop the medication now that he has reached a “normal” BMI. What is the most appropriate response?

C. Continue the medication, as discontinuation is associated with significant weight regain.
Paper for next week:

Ebernella Shirin Dason M, Olexandra Koshkina, Crystal Chan, Mara Sobel, Diagnosis and management of polycystic ovarian syndrome, CMAJ 2024 January 29;196:

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 26 Obesity

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Answers for Episode 25 Hyperthyroidism

Question 1: Diagnosis and Pathophysiology

A 35-year-old woman presents with weight loss, palpitations, and heat intolerance. On examination, she has a diffusely enlarged thyroid with a bruit and mild exophthalmos. Laboratory tests reveal suppressed TSH and elevated free T4. Which of the following is the most appropriate next step to confirm the diagnosis?

C. TRAb (TSH receptor antibody) assay

Question 2: Pharmacologic Management

A 42-year-old woman with newly diagnosed Graves’ disease has a free T4 level that is 2.5 times the upper limit of normal. She is not pregnant. Which of the following is the most appropriate initial dose of methimazole?

C. 30–40 mg daily

Question 3: Treatment Complications

A 29-year-old woman with Graves’ disease is started on methimazole. Three weeks later, she presents with fever and sore throat. Which of the following is the most appropriate next step?

B. Order a complete blood count immediately

Paper for next week:

Gracia Fahed, Laurence Aoun, Morgan Bou Zerdan, Sabine Allam, Maroun Bou Zerdan, Youssef Bouferraa and Hazem I. Assi, Metabolic Syndrome: Updates on Pathophysiology and Management in 2021, Int. J. Mol. Sci. 2022, 23, 786

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 25 Hyperthyroidism

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Answers for Episode 24 Hypothyroidism

Question 1: Cardiovascular Comorbidities

A 58-year-old woman with a 10-year history of subclinical hypothyroidism presents for routine follow-up. Her TSH is persistently 6.8 mIU/L. She reports no symptoms. Which of the following best describes her current cardiovascular risk profile according to population-based evidence?

C. She has an increased risk of cardiovascular disease, even in the absence of symptoms

Question 2: Persistent Symptoms Despite LT4

A 42-year-old man on levothyroxine (LT4) for overt hypothyroidism has normalized TSH but reports persistent fatigue and difficulty losing weight. Labs reveal normal free T4 and T3 levels. What is the most appropriate next step in management?

D. Assess for non-thyroidal causes of symptoms and comorbidities

Question 3: Comorbidity Patterns

Which of the following is most accurately described as a comorbidity that shares a possible genetic or autoimmune pathogenesis with hypothyroidism?

B. Rheumatoid arthritis

Paper for next week:

Susan Z. Yanovski,Jack A. Yanovski, Approach to Obesity Treatment in Primary Care: A Review, JAMA Intern Med. 2024 July 01; 184(7): 818–829.

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 24 Hypothyroidism

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Answers for Episode 23 Type 1 DM

Question 1: Clinical Application of Technology in Older Adults

A 75-year-old man with long-standing Type 1 diabetes is experiencing frequent episodes of severe hypoglycaemia, including nocturnal events. He lives independently with minimal caregiver support. Which of the following interventions is most likely to reduce his risk of hypoglycaemia and improve his quality of life?

C. Initiation of continuous glucose monitoring (CGM) with predictive alerts

Question 2: Understanding Glycaemic Variability

Which of the following best describes the clinical significance of glycaemic variability (GV) in older adults with diabetes?

B. GV is associated with increased risk of cognitive decline, frailty, and mortality

Question 3: Barriers to Technology Use

An 82-year-old woman with Type 1 diabetes, moderate cognitive impairment, and visual deficits is being considered for diabetes technology. Which of the following is the most appropriate next step?

C. Assess cognitive function, dexterity, and social support before initiating technology

Paper for next week:

Sun Y. Lee, Elizabeth N. Pearce, MD, Hyperthyroidism: A Review, JAMA. 2023 October 17; 330(15): 1472–1483.

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

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Episode 12.1 Thoughts on Vaping

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Intro/Outro: Night Detective by Amaksi

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Produced by: Todd Fredricks DO MSS

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Papers referenced:

Avian V.White, David W. Wambui, Lok R. Pokhrel, Risk assessment of inhaled diacetyl from electronic cigarette use among teens and adults, Science of the Total Environment 772 (2021)

E Andrew L. Pipe and Hassan Mir, E- Cigarettes Reexamined: Product Toxicity, Canadian Journal of Cardiology, Volume 38 2022

Rotations 2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS

Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.

Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.